The Pill turns 50

When faced 50 years ago with moral concerns about his discovery of a birth control pill, Dr. Gregory Pincus had a simple response: “I invented the pill at the request of a woman.”

That woman, it turns out, was birth control pioneer Margaret Sanger, who for decades had been searching for a pregnancy prevention pill. Ms. Sanger knew another early feminist, New York philanthropist and scientist Katharine McCormick, who eventually bankrolled the work of Dr. Pincus and Dr. Min-Chueh Chang and their colleagues at the Worcester Foundation for Experimental Biology in Shrewsbury.

How the various players got together to create what became known as the “pill” — 50 years old this month — was a perfect planet alignment, or maybe just happenstance.

“Margaret Sanger approached Dr. Pincus at a Manhattan dinner party, and she was very taken with him,” said Thoru Pederson, a University of Massachusetts Medical School professor who headed the Worcester Foundation from 1985 to 1997. “She was trying to get somebody interested in oral contraceptives, and he was very charismatic.”

The foundation's name was changed to the Worcester Foundation for Biomedical Research and moved to UMass Medical School in Worcester in 1997.

Ms. Sanger convinced the aging Mrs. McCormick, who had married into a wealthy Chicago family, to come to Shrewsbury in 1953 to meet with Dr. Pincus and his colleague and foundation co-founder, Hudson Hoagland, whom he met while both were students and researchers at Harvard University. They eventually left Harvard for Clark University in Worcester before starting the foundation.

“It was an epochal meeting,” Mr. Pederson said of the encounter between Dr. Pincus and Ms. Sanger.

“Pincus had no interest in contraception prevention. He was studying fertility. But he was convinced by Sanger and McCormick that it was important,” he said.

The pill's importance has been validated in its 50 years by widespread use. Today, it is the most commonly used form of birth control, and that first pill, marketed by Searle Pharmaceuticals as Enovid-10, has spawned dozens of brands — Yaz, Lybrel, Seasonale — which all work the same way, by using a combination of hormones to mimic pregnancy and prevent ovulation each month.

Dianne Luby, president and chief executive officer of the Planned Parenthood League of Massachusetts, an organization founded by Ms. Sanger, said 19 percent of woman ages 15 to 44 use birth control pills, and at Planned Parenthood it is the preferred method of birth control for 71 percent of clients.

Several new Planned Parenthood family planning centers have or will soon open in Central Massachusetts, including in Fitchburg, Framingham, Marlboro, Milford, Southbridge and Worcester, to provide greater access to low-cost birth control for areas with high teen pregnancy rates. Central Massachusetts was designated a target area under a program created in the Nixon administration to cut down on abortions, Ms. Luby said. The organization in December received a two-year $1.5 million grant to open the new centers.

“It is ironic to me that although the pill was invented in Worcester, and Massachusetts is always thought of as forward thinking, it was the last state to approve the pill for married women (1966) and for unmarried women, in 1972,” she said.

The pill received provisional approval from the U.S. Food and Drug Administration in May 1960 and final approval in June 1960. There were few clinical trials required, Mr. Pederson said, because Dr. Pincus used Searle drugs already on the market through a deal he made with the company to test adrenal gland hormones. In exchange, he had access to all compounds Searle had on its shelves. A pill containing the same hormones, although not taken daily, had been approved in 1953 to treat menstrual distress, so the researchers were able to move quickly.

“Today, this would have been blocked by patent laws,” Mr. Pederson said.

The first trial took place in Boston, where Dr. John Rock, another Harvard researcher, had a medical practice consisting of working-class women who had babies year after year. He tested the pill on them, and —voila — no more pregnancies. Next, a more scientific study took place in Puerto Rico, where 50 low-income women were recruited. However, several did not stick to the regime, and the trial fell apart. But ironically, a group of nurses and female gynecologists following that study decided to try the pill themselves and enrolled in a second study.

“It was restarted with more educated women, and it was a great success,” Mr. Pederson said. “The drug was already on the market — it never had to go to a second phase — and the results were so dramatic, it was provisionally approved.”

And while the pill's discovery certainly affected women's lives, it did not have the expected impact, according to Elaine Tyler May, author of the new book, “America and the Pill: A History of Promise, Peril and Liberation.”

“It really had no impact at all on sexual behavior; the sexual revolution was already under way. The pill coincided with that,” said Ms. May, a professor of American Studies and History at the University of Minnesota.

In the early 1960s, she said, the pill was heralded as a magic bullet that would stop population explosion, end poverty and ensure happy and stable marriages. But, as the decade went on, people credited — or blamed — the pill for changes in sexual behavior and challenges to authority.

“Women liberated themselves as a result of the feminist movement, and they used the pill as an important tool to gain control over their lives,” she said. “For the first time ever, married women could finally have careers that were totally in their control.”

Today, Ms. May said, the pill is such a part of life, some younger women take it for granted.

“It's like imagining life without a telephone,” she said. “If it had not been for feminists, we would not have been in control of our lives, and our jobs and private lives would still be bound by fertility.”

Amy G. Richter, a history professor at Clark University, said white middle-class women of the 19th century had more control over their fertility than lower-class and minority women of the 20th century.

“Middle-class women were perceived to be morally superior. They could say no to sex; abstain, and track their cycles,” she said. In addition, Ms. Richter said, middle-class women had more access to abortions.

“It's impossible to say the pill did not change society in a variety of ways,” Ms. Richter said. “It was so reliable. It was transformative at so many layers, not in just controlling fertility, but by putting that control into the hands of women.”

Although Dr. Pincus has been called the “father of the pill,” Ms. May takes issue with that. She describes Ms. Sanger and Mrs. McCormick as the “mothers of the pill.”

Mrs. McCormick, who was one of the first women to earn a science degree from the Massachusetts Institute of Technology, in 1904, made an initial $20,000 donation to the Worcester Foundation, Mr. Pederson said, but held off on a second identical amount until she studied their work herself.

“Mrs. McCormick was very knowledgeable about science. She required Pincus to write out all his work and his research plans, which she reviewed and edited,” he said.

“She was very involved in the research progress; she wrote to Pincus every week,” he said. “She deserves a lot of credit.”

Hudson Hoagland, who became chairman of the biology department at Clark University, left Harvard in disgust because, according to Clark University archives, he believed Dr. Pincus was not reappointed at Harvard in 1937 because of his controversial work on in vitro fertilization. Mr. Hoagland later arranged for Dr. Pincus to join his research team at Clark, and the Pincus family moved to Worcester around the time the Hurricane of 1938 struck. With more controversy and strained relationships about their work surfacing at Clark, the two moved the foundation to Shrewsbury in 1945 — with no money, no patients, no students and no patents.

They were so lacking in funds, Dr. Pincus took care of the laboratory animals himself, and Dr. Hoagland mowed the large lawn.

The two were soon joined by Dr. Min-Chueh Chang, who had done research on mammalian reproduction and became co-discover with Dr. Pincus of the birth control pill.

“Dr. Chang was a master on animal studies, and he really catalyzed it,” Mr. Pederson said.